Stroke

Question 1

Define stroke

Answer 1

Reduced blood flow to a part of the brain, depriving it from oxygen and nutrients

Question 2

85% of stroke are due too…

Answer 2

Cerebral infraction

Question 3

Non modifiable risk factors

Answer 3

• age
• gender
• ethnicity

Question 4

Modifiable risk factors

Answer 4

• obesity
• HTN
• diabetes
• AF
• cholesterol
• smocking
• alcohol
• reduced physical activity
• stress

Question 5

Symptoms of stroke?

Answer 5

• quick onset
• slurred speach
• difficulty understanding
• unilateral weakness
• visual disturbance
• hearing loss
• thunder clap headache - In haemorrhage stroke

Question 6

Circle of wills is…

Answer 6

The brains blood supply

Question 7

Middle cerebral artery delivers blood to..

Answer 7

The most outer part of the brain

Question 8

Anterior cerebral artery supplies blood to..

Answer 8

Frontal inner portion

Question 9

Posterior cerebral artery delivers blood to….

Answer 9

Back inner potion

Question 10

Basilar artery delivers blood to….

Answer 10

Brain stem

Question 11

What are the types of strokes?

Answer 11

• TIA
• ischemic stroke
• haemorrhage stroke

Question 12

How long does a TIA attack last for and is it temp or permanent ?

Answer 12

<20mins & temp interruption to blood flow

Question 13

How long do symptoms resolve in?

Answer 13

24hours

Question 14

List examples of Focal neurological deficits

~TIA

Answer 14

• dysphasia
• vertigo & ataxia (unsteadiness)
• unilateral weakness
• loss of vision in one eye
• loss of vision in the same half of both eyes

Question 15

Ischemic stroke occurs due to

Answer 15

Thrombus

Question 16

Ischemic stroke occurs as a result of atherosclerosis or clot formation, which occurs in….

Answer 16

• heart
• ventricles
• AF

Question 17

What is a haemorrhage stroke

Answer 17

Blood vessel ruptures, resulting in bleeding around the brain

Question 18

What does FAST stand for

Answer 18

Face
Arms
Speech (slurred)
Time (call 999)

Question 19

What tool is used the diagnosis of stroke to differentiate between stroke and other symptoms that are similar to stroke

Answer 19

ROSIER

Recognition of stroke in emergency room

Question 20

List examples of stroke mimics

Answer 20

• syncope
• severe migraines
• sepsis
• HYPOglycemia
• space occupying lesions on imaging

Question 21

Which diagnostic methods are used to diagnose stroke

Answer 21

• CT (exclude haemorrhage or IS)
• MRI (preferred in confirmed TIA)
• ECG
• ECHO
• catotid ultrasound
• cerebral angiography
• blood test

Question 22

Initial management of TIA

Answer 22

•STAT - aspirin 300mg
• refer to TIA specialist within 24 hours of symptom onset
• imaging not required

Question 23

Once TIA diagnosis is confirmed, what is the secondary prevention

Answer 23

Anti platelets:
• 1st line: clopidogrel 75mg OD
• 2nd line: Aspirin 75mg with dipyridamole MR 200mg BD
+
• atorvastatin 20-80mg

Question 24

Thrombolysis management of ischemic stroke

Answer 24

If onset of symptoms within <4.5h
• give IV Alteplase
* exclude intercrainial haemorrhag before giving*

If onset >4.5 (with 6-24 hours)
• preform thrombectomy

Question 25

Initial drug management of Ischemic stroke?

Answer 25

• aspirin 300mg OD, 14 days • PPI • Atorvastatin 40mg • oxygen supplement • control blood glucose • control HTN

Question 26

Acute drug management of haemorrhage stroke?

Answer 26

• stop antiplatlets • start surgical intervention (craniotomy or hemicranietctomy) • stop bleeding - vit K or tranexemic acid • reduce BP (systolic <140) • ventricular drainage • statin • nomidopine 60mg every 4 hours (for subarachnoid haemorrhage)

Question 27

Treatment for intracerebral haemorrhage?

Answer 27

Decompressive hemicraniectomy ^needs robbed done within 48h of symptoms onset

Question 28

What complications occur after (all types) strokes

Answer 28

• dysphasia • cognitive dysfunction • co-ordination difficulties • depression • anxiety • speech disorders (dysarthria)

Question 29

Dysphasia is difficult of swallowing, what does dysphasia increase the risk of

Answer 29

• pneumonia • aspiration • malnutrition *tubes are inserted to assist nutrition and medication requirements*

Question 30

How is nasogastric tube inserted,

Answer 30

Inserted into the stomach via nose

Question 31

How is nasojejunal inserted

Answer 31

Into the jejunum via nose

Question 32

How is percutaneous endoscopic gastrostamy inserted?

Answer 32

Into the stomach via abdominal wall

Question 33

How is percutaneous endoscopic jejunostomy inserted?

Answer 33

Into the jejunum via abdominal wall

Question 34

How is percutaneous endoscopic gastro-jejunostomy inserted?

Answer 34

Into jejunum via abdominal wall and stomach

Question 35

When should tube positing be checked?

Answer 35

• after inserting • before feeds • before administration of meds • once daily during continuous feed • evidence of displacement • after coughing, vomiting or retching

Question 36

How can tube position be check

Answer 36

• imaging - but too much radiation • pH

Question 37

At which pH is it okay to start feeding?

Answer 37

5.5 or below *if over do not use and wait for gastric acids to rise* Some patient may be on gastroprotection drugs, thus pH is over 6 - use imaging instead of pH testing

Question 38

How does external feeding tubes affect drug absorption?

Answer 38

The drug will be in the stomach for a small amount of time, affecting the absorption, especially if it requires acidic environments for dissolution

Question 39

What type of water is required for enternal feeding tube and why?

Answer 39

Sterile - because it reduces risk of infection and contamination

Question 40

How much ml of water is required to flush enternal tubes?

Answer 40

10-30ml

Question 41

What is the maximum time water can be left for?

Answer 41

24 hours

Question 42

What can occur if drugs are mixed together via enternal tube

Answer 42

• blockages • interactions

Question 43

Are injections with high polyethylene gycol content suitable for enternal feedings and give example?

Answer 43

No Example: vancomycin